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t ; <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 ppSy.{o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /5' <br /> VALID T DRIVEWAYS: <br /> Pacific Gas and Electric: Co. ; STREET ` <br /> P.O. Box 930 AREA Sn/ QUAD• S ` <br /> Stockton, CA 95201 TYPE u. ° <br /> FORMS �Z <br /> NOTES <br /> I <br /> ;?0 9 } 9z12 -I yqL� <br /> (Area Co e-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per ' <br /> PM 30Bq209�7i current M.U.T.C.D. + <br /> Notif. California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EA.97- side of 9. Aut' approximately SS feet/m#e- A/oR7-,A/ <br /> of F/912MM16 r43" RD. , sr42cKT0A1 by performing the following work(description of work): <br /> euT oF,c- 614S S,6512 tele E 7-b yoiS <br /> ouci2 4,4.3 MAII! 4A1i1 cur oFF S�Ru�cC. <br /> 41-c19LJ147-IDA1 Ty T.1/CE !'LEGE ZAI Pyye17JEAlT. <br /> Work will commence on or about 6- FEB-/2 for approximately 4o days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Q Signature of Applicant-Title Date <br /> E:WUBSV.WkWASTERPSENCROACFWEM PEWff APPUGTIONAOC (D») <br />